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| The choices of medications to use when treating children who have JRA are similar to those used to treat adult forms of rheumatoid arthritis. However, the doses may need to be adjusted accordingly, based on the size and weight of the child. Preference may be given to liquid preparations or medicines needed less frequently, to help with compliance. In past years, doctors used a pyramid or step-up approach to prescribing meds for children with JRA. The non-steroidal anti-inflammatory drugs (commonly referred to as NSAIDs) were considered a first-line treatment. That is, the first type of medication to try. These are the mildest medications used to help alleviate the symptoms of JRA: inflammation and pain. These include such drugs as ibuprophin, naproxin, and indomethacin. A newer category of meds has recently been developed. These are called Cox II Inhibitors, such as Vioxx and Celebrex. These will sometimes be prescribed to children who have difficulty tolerating conventional NSAIDs, as they are reported to cause less frequency of gastrointestinal disturbance. In cases where stomache irritation becomes a concern, a doctor will often prescribe something else, like Zantac or Cytotec, to help to remedy the problem. Another class of commonly prescribed and often very effective medications is known as the disease modifying anti rheumatic drugs (DMARDs) or slow-acting anti-inflammatory drugs (SAAIDs), since it unfortunately usually takes between several weeks to several months before they begin working. They used to be known as second-line meds and were used only after the symptoms of arthritis were not controlled well enough by a trial period of NSAIDs alone. This line of thinking is changing. It's becoming more common among rheumatologists to begin using these so-called second-line meds earlier on in this course of disease, as research has shown that they have the ability to change the course of the disease and are among the most effective at limiting the potential severe of destruction to joints and cartilege that JRA can cause. Some of the common medications included in this group are Methotrexate (MTX), Sulfasalazine, and Plaquinel (Hydroxychloroquine). Corticosteroids are sometimes included in the treatment plan for children with JRA. These include Prednisone, Prednisolone, and Solumedrol. These meds can be administered orally, through an IV, or in other preparations can be injected directly into joints. The newest medications being used to treat JRA are known as biologicals. The most popular and promising right now are medications called Enbrel and Remicade. I'll talk more about this when I have a chance to do an update here. Right now though, it's time to help the children with their homework. Sorry about that. |
| Treatment of JRA |
| What Kinds of Treatments are Available? |
| If you are concerned that your child may be exhibiting some of the signs or symptoms of Juvenile Rheumatoid Arthritis, you should make an appointment for your child to be seen by his or her general practitioner or pediatrician. After an intial evaluation, you and your child will likely be referred to a doctor who specializes in the treatment of children who have arthritis. Pediatric rheumatologists have received specialized education and training. They have the experience necessary to provide the best treatment and are equipped to manage the ongoing health care needs of children with JRA. In some areas, however, there is a shortage of board certified pediatric specialists. Depending on your location you may have to arrange for your child to be seen, instead, by a rheumatologist who treats children as well as adults. The American College of Rheumatology maintains a searchable index of rheumatologists, which may help you locate a doctor. It's likely that you will also need to make an appointment to have your child examined by an ophthalmologist, a doctor who specializes in the treatment of eye disease. Your child may need to be evaluated by physical and occupational therapists who can provide individualized exercises to help preserve joint function and advise on the suitability of splints and assistive devices. Many families find it helpful, at some point, to seek services provided by social workers and child psychologists for guidance with particularly challenging issues. An orthopedic specialist will likely be involved in your child's medical care, to monitor changes in joints which have been affected by arthritis. These doctors can do casting and perform corrective surgeries such as joint replacements, as necessary. As you can see, the treatment of a child who has JRA requires a team approach. The health care team usually consists of the child's pediatrician, pediatric rheumatologist, nurse practitioners, orthopedic specialist, school health aides, ophthalmologist, physical and occupational therapists, social worker or child psychologist, and last but certainly not least ... caring and supportive family members, such as yourself. |
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| Georgina's Juvenile Rheumatoid Arthritis Pages |
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